Cognitive Behavioral Therapy for Kids

People with OCD feel the need to repeat habits over and over, but at the same time that they are feeling compelled to do the behavior (habit) they are also aware that it is irrational. These compulsions can grow and interfere with a person’s life in a multitude of ways. Earlier studies have found that people with OCD have brain differences in the areas around habit formation and the related “supervisory role” over the relevance/use of habits.

A recent study at the University of Cambridge looked at the brain activity of people in the process of forming new habits. In the study, 37 people diagnosed with OCD and 33 people without, were taught to avoid a mild shock while by pressing their foot down on a pedal. Everyone in the study adopted the habit of pressing down on the pedal, but the people with OCD continued to press on the pedal even after the threat of the shock had ended.

The people with OCD showed abnormal brain activity in the supervisory “goal-directed” areas of the brain; the area that should have told them “Enough! You can stop now.”. They had no differences in the areas of habit formation. This study suggests that people with OCD can learn habits effectively, but have a glitch in the way their frontal lobes monitor and direct their goal-directed behavior which allows their habits to keep going and going.

This study is relevant in the treatment of OCD for several reasons. First, the cognitive training specific to the “goal-directed” areas may be a useful intervention for OCD. Second, this fact-based understanding may help some people with OCD “talk back” to the urges. If we can understand why something is happening, it can often make it less scary.

Researchers used Google search queries in the US and in Australia to look at seasonal patterns relating to anxiety, OCD, bipolar disorder, depression, and more. The researchers found that there were clear patterns of increased searches for mental illness during the winter months.

This study, which appeared in the May 2013 issue of The American Journal of Preventive Medicine, looked more closely at the impact of daylight, physical activity, and vitamin levels in blood as they relate to mood and to season. I came across a NY Times summary of this article just recently as I was noticing a number of kids I work with reporting increased mood and energy recently. While this idea is certainly not new, the research method and content caught my eye. Additionally, this was a preliminary study. At the very least it gives some credibility to an intuitive knowledge of the winter blues, and it also makes a case for strengthening coping resources PRIOR to winter’s onset. Hopefully it gives researchers data to explore the effect of seasonality on different types of mental illness and will lead to new treatment options (and maybe a winter trip to the beach. J)

A new study published in this month’s JAACAP showed that children diagnosed with an anxiety disorder who then received CBT (and had a positive effect) were less likely to have thoughts about suicide or attempt suicide in their later teens. Previous research has looked at correlations between childhood anxiety and future depression/suicidality in teens, but the research has been mixed and inconsistent.

In the current study, the authors hypothesized that a positive response to CBT in early childhood could have a lasting preventive mental health effect over time. And while the authors in this study were primarily looking at anxiety and future suicidality, this study also adds to the growing body of research on the use of CBT preventively in childhood.

In general, school systems are reluctant to address mental health issues that don’t directly interfere with a student’s ability to learn. However, there is increasing research that shows the importance of prevention-based intervention in reducing anxiety and depression. The prevention research protocols usually involves a CBT-based intervention that teaches the impact of thoughts on feelings, and identifies positive coping behaviors to use in times of stress/distress.
Programs like Martin Seligman’s Penn Resiliency Project (http://www.ppc.sas.upenn.edu/prpsum.htm) have showed the effectiveness of basic preventive intervention in school settings, but implementation of such programs is infrequent. A recent study in the journal Prevention Science demonstrated a novel way to increase the relevance of prevention efforts in schools and to apply this research-based information in a school setting.

The study took place in a Louisiana school system and was targeted towards test anxiety. In the study, students were taught specific CBT techniques to manage test anxiety. And while the program was specifically targeted to manage anxiety associated with tests; the researchers found the students were able to use the information and skills learned to decrease their overall feelings of depression and anxiety.

CBT is skills-based, is designed to teach participants to learn about the problem and develop personal tools to manage their own symptoms. Using this type of intervention preventively for a school-specific issue (i.e., test anxiety) provides a wonderfully unique way of implementing change for the defined problem and also allows for a generalization of skills.

The authors of the study clearly state that this is not an appropriate intervention for acute anxiety or depression, it nonetheless is a way to preventively teach young people skills that can aid them in school and beyond. The increasing body of knowledge about the preventive effects of CBT makes a strong case for teaching these basic skills to children as part of any health curriculum.

The New York Times recently ran an article written by the mom of a depressed teen. The mother shared the helplessness and fear she felt with great eloquence, and she also shared an unorthodox but quite wonderful strategy for showing her love and support.

Throughout the several year struggle, the mother routinely slipped her daughter poems; leaving the poems, copied in different ways and different styles, in her daughter’s shoes. These were poems of encouragement, poems of solidarity, and poems of hope. These were not the poems of a Hallmark card but were instead intellectual and dynamic; they were poems that inspired thought and reflection.
The author reflected that she didn’t know if her daughter’s recovery from depression was a result of maturity, professional intervention, or if the poems played any role at all. And while I believe that the poems themselves were important, I am even more impressed by the persistent and creative way that this parent reached out to her sad daughter.

Teens often reject parents, and depressed teens are even more likely to shut out those who love them the most. This parent found a way to communicate her support and unconditional love, and that in itself had to play a role in her daughter’s journey. It is hard to continue to show love through repeated rejection, and it is hard to find ways to support kids who shut you out, but it is worth remembering this story of the mother who slipped poems in her daughter’s shoes when we feel at our most helpless.